Akut kolesistitin ciddi bir komplikasyonu olan safra kesesi perforasyonunun klinik yönetimi: yüksek volümlü tek merkez sonuçlarımız
Öz
Amaç:
Safra kesesi perforasyonu akut kolesistitin(AK) morbidite ve mortalite oranlarını artıran en ciddi komplikasyonudur. Akut perfore kolesistit (APK) yönetiminde net bir algoritma olmamakla birlikte erken dönemde operasyona uygun olmayan hastalar konservatif takip edilebilmektedir.Çalışmamızda APK nedeniyle takip edilen hastaların sonuçlarını değerlendirerek klinik deneyimimizi sunmayı amaçladık.
Gereç ve yöntem
Çalışmaya Aralık 2018- Aralık 2023 yılları arasında AK nedeniyle kliniğimizde takip edilen 532 hasta dahil edildi. Safra kesesi perforasyonu olmayan hastalar dışlanarak 118 hastanın verileri retrospektif tarandı.
Bulgular
Hastaların 53(%44,9)’ü kadın, 65(%55,1) erkek idi. Ortalama yaş 67,7(23-93) idi. Hastaların 17(%14,4)’sine medikal tedavi,73(%61,9)’üne perkutan kolesistostomi (PK),15(%12,7)’ine PK uygulama sonrası operasyon ve 13(%11)’üne operasyon uygulandı. Operasyon uygulananların 13(%46,4)’ü interval dönemde, 15(%53,6)’i elektif opere edildi. Elektif operasyon planlanan hastalar ortalama APK tanısından 116 gün sonra opere edildi. Operasyon zamanlamasının yatış süresi, operasyon türü ve sağkalıma etkisi saptanmadı. Hastaların tedavi türleri ve laboratuar değerleri karşılaştırıldığında C-Reaktif Protein/Albumin (CRP/ALB) değerinin anlamlı olarak PK uygulananlarda daha yüksek olduğu görüldü(p=0,008). Hastaların 13(%11)’ü yatışında eksitus oldu. Eksitus olan hastaların yaş ortalaması 80,1 iken olmayanlarınki 66,1 olarak saptandı (p=0,0007). Bunların 11(%84,6)’ine PK uygulanırken 2(%15,4)’si yalnızca medikal tedavi ile takip edildi.
Sonuç
APK tanısı alan erken dönemde operasyona uygun olmayan hastalarda konservatif tedavi seçenekleri tercih edilebilmekte ancak PK uygulaması hastane yatış sürelerini uzatmaktadır. APK mevcut olan hastalarda hastaya spesifik tedavi tercihlerinin yapılmasının doğru olacağını düşünmekteyiz.
Anahtar Kelimeler
Akut Kolesistit Akut Perfore Kolesistit Perkutan Kolesistostomi Kolesistektomi Safra Kesesi
Etik Beyan
Etik İnceleme Komitesi Beyanı: Bu çalışma Helsinki Deklarasyonu'na uygundur. Biz (tüm yazarlar) Derginin etik yayıncılıkla ilgili konulardaki pozisyonunu okuduğumuzu ve bu raporun bu yönergelerle tutarlı olduğunu teyit ediyoruz. Etik Kayıt numarası: 24-7T/89 Çalışma Ege Üniversitesi Genel Cerrahi Anabilim Dalı'nda yürütüldü ve etik kurul onayı 24-7T/89 alındı
Kaynakça
- Ausania, F., Suárez, S., Garcia, H., Rio, P., & Núñez, E. (2015). Gallbladder perforation: morbidity, mortality and preoperative risk prediction. Surgical Endoscopy, 29, 955-960. https://doi.org/10.1007/s00464-014-3765-6.
- Jansen, S., Doerner, J., Macher-Heidrich, S., Zirngibl, H., & Ambe, P. (2017). Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in Germany. Surgical Endoscopy, 31, 1896-1900. https://doi.org/10.1007/s00464-016-5190-5.
- Menakuru, S.R., Kaman, L., Behera, A., Singh, R. and Katariya, R.N. (2004), Current management of gall bladder perforations. ANZ Journal of Surgery, 74: 843-846. https://doi.org/10.1111/j.1445-1433.2004.03186.x
- Pak M, Lindseth G. (2016) Risk factors for cholelithiasis. Gastroenterol Nurs 39:297–309. https://doi.org/10.1097/SGA.0000000000000235.
- Date, R., Thrumurthy, S., Whiteside, S., Umer, M., Pursnani, K., Ward, J., & Mughal, M. (2012). Gallbladder perforation: case series and systematic review.. International journal of surgery, 10 2, 63-8 . https://doi.org/10.1016/j.ijsu.2011.12.004.
- Wani, A., Iqbal, J., & Parihar, S. (2023). A retrospective study of diagnosis and management of gallbladder perforation: 10-year experience from a tertiary health care centre.. Turkish journal of surgery, 39 2, 102-106 . https://doi.org/10.47717/turkjsurg.2023.5962.
- Morris BS, Balpande PR, Morani AC, Chaudhary RK, Maheshwari M, Raut AA. (2007) The CT appearances of gallbladder perforation. Br J Radiol 80:898–901.https://doi.org/10.1259/bjr/28510614.
- Aydin, C., Altaca, G., Berber, I. et al. Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg 13, 155–159 (2006). https://doi.org/10.1007/s00534-005-1042-8
- Ong, C., Wong, T., & Rauff, A. (1991). Acute gall bladder perforation--a dilemma in early diagnosis.. Gut, 32, 956 - 958. https://doi.org/10.1136/GUT.32.8.956.
- Niemeier, O. W. M.D., F.R.C.S. (edin.). ACUTE FREE PERFORATION OF THE GALL-BLADDER. Annals of Surgery 99(6):p 922-924, June 1934.https://doi.org/10.1097/00000658-193499060-00005
- Anderson BB, Nazem A. Perforations of the gallbladder and cholecy- stobiliary fistulae: A review of management and a new classification. J Natl Med Assoc 1987; 79(4): 393-9.
- Takada, T., Yasuda, H., Uchiyama, K., Hasegawa, H., Asagoe, T., & Shikata, J. (1989). Pericholecystic abscess: classification of US findings to determine the proper therapy.. Radiology, 172 3, 693-7 . https://doi.org/10.1148/RADIOLOGY.172.3.2672094.
- G. Wakabayashi et al. "Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)." Journal of Hepato‐Biliary‐Pancreatic Sciences, 25 (2018). https://doi.org/10.1002/jhbp.517.
- Derıcı, H., Kara, C., Bozdağ, A., Nazlı, O., Tansuğ, T., & Akca, E. (2006). Diagnosis and treatment of gallbladder perforation.. World journal of gastroenterology, 12 48, 7832-6 . https://doi.org/10.3748/WJG.V12.I48.7832.
- Lein, H.-H. and Huang, C.-S. (2002), Male gender: Risk factor for severe symptomatic cholelithiasis. World J. Surg., 26: 598-601. https://doi.org/10.1007/s00268-001-0275-1
- Ambe, P., & Köhler, L. (2015). Is the male gender an independent risk factor for complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis?. International surgery, 100 5, 854-9 . https://doi.org/10.9738/INTSURG-D-14-00151.1.
- Quiroga-Garza, A., Álvarez-Villalobos, N., Angeles-Mar, H., García-Campa, M., Muñoz-Leija, M., Salinas-Alvarez, Y., Elizondo-Omaña, R., & Guzmán-López, S. (2021). Localized gallbladder perforation: a systematic review of treatment and prognosis.. HPB : the official journal of the International Hepato Pancreato Biliary Association. https://doi.org/10.1016/j.hpb.2021.06.003.
- Derıcı, H., Kamer, E., Kara, C., Ünalp, H., Tansuğ, T., Bozdağ, A., & Nazlı, O. (2011). Gallbladder perforation: clinical presentation, predisposing factors, and surgical outcomes of 46 patients.. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 22 5, 505-12 . https://doi.org/10.4318/TJG.2011.0246.
- Strohl EL, Diffenbaugh WG, Baker JH, Chemma MH: Collective reviews: gangrene and perforation of the gallbladder. Int Abstr Surg. 1962, 114: 1-7.
- Wang AJ, Wang TE, Lin CC, Lin SC, Shih SC. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol 2003; 9(12): 2821-823. https://doi.org/10.3748/wjg. v9.i12.2821
- Rajput, D., Gupta, A., Kumar, S., Singla, T., Srikanth, K., & Chennatt, J. (2022). Clinical spectrum and management outcome in gallbladder perforation-a sinister entity: Retrospective study from Sub-Himalayan region of India.. Turkish journal of surgery, 38 1, 25-35 . https://doi.org/10.47717/turkjsurg.2022.5325.
- K. Okamoto et al. "Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis." Journal of Hepato‐Biliary‐Pancreatic Sciences, 25 (2018). https://doi.org/10.1002/jhbp.516.
- Kochar K, Vallance K, Mathew G, Jadhav V. (2008) Intrahepatic perfo- ration of the gall bladder presenting as liver abscess: case report, review of literature and Niemeier’s classification. Eur J Gastroenterol Hepatol 20:240–244. https://doi.org/10.1097/MEG.0b013e3282eeb520.
- HussainT,AdamsM,AhmedM,ArshadN,SolkarM.(2016)Intrahepatic perforation of the gallbladder causing liver abscesses: case studies and literature review of a rare complication. Ann R Coll Surg Engl 98: e88–e91. https://doi.org/10.1308/rcsann.2016.0115.
- Jansen, S., Stodolski, M., Zirngibl, H., Gödde, D., & Ambe, P. (2018). Advanced gallbladder inflammation is a risk factor for gallbladder perforation in patients with acute cholecystitis. World Journal of Emergency Surgery : WJES, 13. https://doi.org/10.1186/s13017-018-0169-2.
- Glenn F, Moore SW. Gangrene and perforation of the wall of the gallbladder. A sequele of acute cholecystitis. Arch Surg1942; 44: 677-686
Clinical Management of Gallbladder Perforation, a Serious Complication of Acute Cholecystitis: Our High-Volume Single-Center Results
Öz
Aim
Gallbladder perforation is the most serious complication of acute cholecystitis (AC), increasing morbidity and mortality rates. Although there is no clear algorithm for managing acute perforated cholecystitis (APC), patients who are not suitable for surgery in the early period can be followed conservatively. Our study aimed to present our clinical experience by evaluating the results of patients who were followed up due to APC.
materyals and Method
The study included 532 patients followed up in our clinic due to AC between December 2018 and December 2023. Patients without gallbladder perforation were excluded, and the data of 118 patients were retrospectively reviewed.
Results
53 (44.9%) of the patients were female, 65 (55.1%) were male. The mean age was 67.7 (23-93). 17 (14.4%) of the patients received medical treatment, 73 (61.9%) received percutaneous cholecystostomy (PC), 15 (12.7%) underwent surgery after PC, and 13 (11%) underwent surgery. 13 (46.4%) of those who underwent surgery were operated on in the interval period, and 15 (53.6%) were operated on electively. Patients who were planned for elective surgery were operated on an average of 116 days after the diagnosis of APC. No effect of the timing of the surgery on the length of stay, type of surgery, and survival was detected. When the treatment types and laboratory values of the patients were compared, it was seen that the C-reactive protein/Albumin (CRP/ALB) value was significantly higher in those who underwent PC (p=0.008). Thirteen (11%) of the patients died during hospitalization. The mean age of the patients who died was 80.1, while the mean age of those who did not was 66.1 (p=0.0007). While 11 (84.6%) underwent PK, 2 (15.4%) were only followed up with medical treatment.
Conclusion
Conservative treatment options can be preferred in patients diagnosed with APC who are not suitable for surgery in the early period, but PK application prolongs the hospital stay. We think making patient-specific treatment preferences in patients with APC would be correct.
Keywords: Acute Cholecystitis, Acute Perforated Cholecystitis, Percutaneous Cholecystostomy, Cholecystectomy, Gallbladder
Anahtar Kelimeler
Acute Cholecystitis Acute Perforated Cholecystitis Percutaneous Cholecystostomy Cholecystectomy Gallbladder
Kaynakça
- Ausania, F., Suárez, S., Garcia, H., Rio, P., & Núñez, E. (2015). Gallbladder perforation: morbidity, mortality and preoperative risk prediction. Surgical Endoscopy, 29, 955-960. https://doi.org/10.1007/s00464-014-3765-6.
- Jansen, S., Doerner, J., Macher-Heidrich, S., Zirngibl, H., & Ambe, P. (2017). Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in Germany. Surgical Endoscopy, 31, 1896-1900. https://doi.org/10.1007/s00464-016-5190-5.
- Menakuru, S.R., Kaman, L., Behera, A., Singh, R. and Katariya, R.N. (2004), Current management of gall bladder perforations. ANZ Journal of Surgery, 74: 843-846. https://doi.org/10.1111/j.1445-1433.2004.03186.x
- Pak M, Lindseth G. (2016) Risk factors for cholelithiasis. Gastroenterol Nurs 39:297–309. https://doi.org/10.1097/SGA.0000000000000235.
- Date, R., Thrumurthy, S., Whiteside, S., Umer, M., Pursnani, K., Ward, J., & Mughal, M. (2012). Gallbladder perforation: case series and systematic review.. International journal of surgery, 10 2, 63-8 . https://doi.org/10.1016/j.ijsu.2011.12.004.
- Wani, A., Iqbal, J., & Parihar, S. (2023). A retrospective study of diagnosis and management of gallbladder perforation: 10-year experience from a tertiary health care centre.. Turkish journal of surgery, 39 2, 102-106 . https://doi.org/10.47717/turkjsurg.2023.5962.
- Morris BS, Balpande PR, Morani AC, Chaudhary RK, Maheshwari M, Raut AA. (2007) The CT appearances of gallbladder perforation. Br J Radiol 80:898–901.https://doi.org/10.1259/bjr/28510614.
- Aydin, C., Altaca, G., Berber, I. et al. Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg 13, 155–159 (2006). https://doi.org/10.1007/s00534-005-1042-8
- Ong, C., Wong, T., & Rauff, A. (1991). Acute gall bladder perforation--a dilemma in early diagnosis.. Gut, 32, 956 - 958. https://doi.org/10.1136/GUT.32.8.956.
- Niemeier, O. W. M.D., F.R.C.S. (edin.). ACUTE FREE PERFORATION OF THE GALL-BLADDER. Annals of Surgery 99(6):p 922-924, June 1934.https://doi.org/10.1097/00000658-193499060-00005
- Anderson BB, Nazem A. Perforations of the gallbladder and cholecy- stobiliary fistulae: A review of management and a new classification. J Natl Med Assoc 1987; 79(4): 393-9.
- Takada, T., Yasuda, H., Uchiyama, K., Hasegawa, H., Asagoe, T., & Shikata, J. (1989). Pericholecystic abscess: classification of US findings to determine the proper therapy.. Radiology, 172 3, 693-7 . https://doi.org/10.1148/RADIOLOGY.172.3.2672094.
- G. Wakabayashi et al. "Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)." Journal of Hepato‐Biliary‐Pancreatic Sciences, 25 (2018). https://doi.org/10.1002/jhbp.517.
- Derıcı, H., Kara, C., Bozdağ, A., Nazlı, O., Tansuğ, T., & Akca, E. (2006). Diagnosis and treatment of gallbladder perforation.. World journal of gastroenterology, 12 48, 7832-6 . https://doi.org/10.3748/WJG.V12.I48.7832.
- Lein, H.-H. and Huang, C.-S. (2002), Male gender: Risk factor for severe symptomatic cholelithiasis. World J. Surg., 26: 598-601. https://doi.org/10.1007/s00268-001-0275-1
- Ambe, P., & Köhler, L. (2015). Is the male gender an independent risk factor for complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis?. International surgery, 100 5, 854-9 . https://doi.org/10.9738/INTSURG-D-14-00151.1.
- Quiroga-Garza, A., Álvarez-Villalobos, N., Angeles-Mar, H., García-Campa, M., Muñoz-Leija, M., Salinas-Alvarez, Y., Elizondo-Omaña, R., & Guzmán-López, S. (2021). Localized gallbladder perforation: a systematic review of treatment and prognosis.. HPB : the official journal of the International Hepato Pancreato Biliary Association. https://doi.org/10.1016/j.hpb.2021.06.003.
- Derıcı, H., Kamer, E., Kara, C., Ünalp, H., Tansuğ, T., Bozdağ, A., & Nazlı, O. (2011). Gallbladder perforation: clinical presentation, predisposing factors, and surgical outcomes of 46 patients.. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 22 5, 505-12 . https://doi.org/10.4318/TJG.2011.0246.
- Strohl EL, Diffenbaugh WG, Baker JH, Chemma MH: Collective reviews: gangrene and perforation of the gallbladder. Int Abstr Surg. 1962, 114: 1-7.
- Wang AJ, Wang TE, Lin CC, Lin SC, Shih SC. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol 2003; 9(12): 2821-823. https://doi.org/10.3748/wjg. v9.i12.2821
- Rajput, D., Gupta, A., Kumar, S., Singla, T., Srikanth, K., & Chennatt, J. (2022). Clinical spectrum and management outcome in gallbladder perforation-a sinister entity: Retrospective study from Sub-Himalayan region of India.. Turkish journal of surgery, 38 1, 25-35 . https://doi.org/10.47717/turkjsurg.2022.5325.
- K. Okamoto et al. "Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis." Journal of Hepato‐Biliary‐Pancreatic Sciences, 25 (2018). https://doi.org/10.1002/jhbp.516.
- Kochar K, Vallance K, Mathew G, Jadhav V. (2008) Intrahepatic perfo- ration of the gall bladder presenting as liver abscess: case report, review of literature and Niemeier’s classification. Eur J Gastroenterol Hepatol 20:240–244. https://doi.org/10.1097/MEG.0b013e3282eeb520.
- HussainT,AdamsM,AhmedM,ArshadN,SolkarM.(2016)Intrahepatic perforation of the gallbladder causing liver abscesses: case studies and literature review of a rare complication. Ann R Coll Surg Engl 98: e88–e91. https://doi.org/10.1308/rcsann.2016.0115.
- Jansen, S., Stodolski, M., Zirngibl, H., Gödde, D., & Ambe, P. (2018). Advanced gallbladder inflammation is a risk factor for gallbladder perforation in patients with acute cholecystitis. World Journal of Emergency Surgery : WJES, 13. https://doi.org/10.1186/s13017-018-0169-2.
- Glenn F, Moore SW. Gangrene and perforation of the wall of the gallbladder. A sequele of acute cholecystitis. Arch Surg1942; 44: 677-686
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Gastroenteroloji Cerrahisi, Genel Cerrahi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Aralık 2024 |
| Gönderilme Tarihi | 29 Temmuz 2024 |
| Kabul Tarihi | 14 Ağustos 2024 |
| Yayımlandığı Sayı | Yıl 2024 |